Diarrhoea is defined as a loose or watery stool and stool frequency of more than 3 times a day. It is one of the most common conditions seen by GPs in Singapore. There are two types of diarrhoea – acute and chronic, which can be quite different in terms of investigation and management. Acute diarrhoea is more prevalent than chronic diarrhoea, affecting 15 to 25 percent of the population annually as compared to the latter at 5 percent.
While acute diarrhoea is almost always due to foodborne and bacterial infections, there are many causes of chronic diarrhoea including irritable bowel syndrome (IBS) and food intolerance. Other serious underlying health conditions may also be the cause such as thyroid disease, digestive cancers, chronic pancreatitis and inflammatory bowel disease.
Diagnosing Acute VS Chronic Diarrhoea
The first priority is to determine whether the patient is suffering from acute (which lasts for 2 weeks or earlier) or chronic or persistent diarrhoea (with a duration of more than 4 weeks).
In acute diarrhoea, the patient is checked for the severity of illness, fever and blood in stool, and travel history. Doctors may start the treatment for diarrhoea without any investigations, but based on clinical history. Stool microbiological assessment may be considered for varying acute diarrhoea conditions like prolonged watery diarrhoea that occurs for more than a week, followed by an antibiotic treatment.
It is important in chronic diarrhoea to differentiate between functional and organic diarrhoea. Most chronic diarrhoea requires specialist referral for further investigations involving endoscopy and imaging especially those with a family history of digestive cancer, diarrhoea that affects quality of life, diarrhoea that occurs even while asleep, oily or pale stool, blood in stool and having blood in the stool.
Most cases of chronic diarrhoea should be referred to a gastroenterology specialist to determine the underlying conditions for further management except cases that responded easily to lifestyle and diet modification, such as low FODMAP diet and gluten-restricted diets, alongside fiber supplements, probiotics, and anti-diarrhoeal medication. In the majority of the cases, up to 70 percent of patients with initial diagnosed functional diarrhoea report that basic medication does not control their diarrhoea symptoms adequately. Differentiating functional diarrhoea from a more serious organic cause may not be easy in these cases.
The key aim of alleviating symptoms of acute diarrhoea is to prevent dehydration and the imbalance of electrolyte. In order to optimize fluid and salt intake, patients will be advised to consume sufficient water, sports drinks, juices, saltine crackers and even oral rehydration salts for moderate-to-severe cases. GPs can also provide charcoal tablets and probiotics, as antibiotics should only be considered for cases like dysenteric diarrhoea, severe watery diarrhoea with fever and travel-associated diarrhoea.
If you are suffering from chronic diarrhoea and simple measures mentioned above have failed to control the symptoms, talk to our specialists at gutCARE in Singapore. Our team of highly experienced doctors will be able to work with you to determine the cause of your symptoms and give you relief. Some Investigations that we carry out for chronic diarrhoea include hydrogen-methane breath tests, colonoscopy with colon biopsy, Imaging studies for pancreas, stool tests and blood test.
Aside from prescription medication or over-the-counter drugs, the symptoms of diarrhoea can be managed with measures like replacing fluid losses to avoid dehydration, reducing certain food intake to avoid aggravating the diarrhoea and eating low-fiber foods.
At gutCARE, we can help you. You can also approach any of our friendly staff to inquire about how our clinic can help and also the costs involved.
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